Prize Claim

Initial Prize Claim Form For 2022 AAGB Event

Anything over a $600 prize or cash is subject to Federal and State taxes and will receive a W-2G Form. Anything over $5,000.00 the taxes must be paid prior to receiving the prize or deducted from the cash prize

IRS Form 5754 MUST BE COMPLETED and Uploaded with your prize claim below. Please click the button below to open the form. You can then save to your local PC and upload in the appropriate form field below

Prize Claim

This form is to be used as your initial contact form to submit your prize claim for the 9th Annual All American Grand Bash

Once submitted and initial confirmation completed, you will receive a follow-up email where you can submit the legally required documents to finalize your claim.

First Name

Last Name

Email Address

Confirm Email Address

Phone Number

Street Address

City

State

Zip Code

Gender

Birth Date

Age

Social Security Number

What type of Prize are you claiming?

What is your winning prize number?

Do You Want the Prize or Cash Value?

Cash Value

Address to Ship Check To

If you were a custom gun winner, do you want the cash value or more info on the custom gun type ?

If you were a gun winner, where would you like to pickup your item?

FFL Dealer Info

Winning Ticket Photo Upload

Photo ID Upload - Drivers License, Passport

Other required ID - (Social Security Card, W2, Tax Return, or other document that displays entire Social Security Number)

Form 5754 Document Upload (Document linked above)

Acceptance of Terms

By my submission, I indemnify Operation Welcome Home, WVU Medicine (WVU Medicine Children's), Hoss Foundation, BashTix, & Mission For Miracles for any loss which may result if any of the information is not true and accurate. I also authorize the use of my name and photograph for any reasonable publicity purposes.
Under penalty of perjury, I declare that to the best of my knowledge and belief (1) the name, address, and social security number, which I furnished correctly identify me as the recipient of this payment or item; (2) no other person is entitled to this prize; and (3) I am not a person disqualified by law from claiming and/or accepting this prize.

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AAGB 2022 Prize Claim Form

Label: Your Field Value

Prize Claim

Anything over a $600 prize or cash is subject to Federal and State taxes and will receive a W-2G Form. Anything over $5,000.00 the taxes must be paid prior to receiving the prize or deducted from the cash prize

IRS Form 5754 MUST BE COMPLETED and Uploaded with your prize claim below. Please click the button below to open the form. You can then save to your local PC and upload in the appropriate form field below

Prize Claim

Office

Prizes

Information

Contact

About

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WV Annual Raffle License # 2397-7207